Healthcare Provider Details

I. General information

NPI: 1639034275
Provider Name (Legal Business Name): DESIRE NZISABIRA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11308 E FERRET DR
SPOKANE VALLEY WA
99206-9479
US

IV. Provider business mailing address

11308 E FERRET DR
SPOKANE VALLEY WA
99206-9479
US

V. Phone/Fax

Practice location:
  • Phone: 682-234-2866
  • Fax: 509-545-4059
Mailing address:
  • Phone: 682-234-2866
  • Fax: 509-545-4059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberNC61530601
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: